'Boiled egg' in the peritoneal cavity-a giant peritoneal loose body in a 64-year-old man: a case report

Abstract

Introduction: Peritoneal loose bodies, or peritoneal mice, are rare asymptomatic lesions that are usually found as an incidental finding during abdominal surgery or autopsy. Giant loose bodies, measuring more than 5 cm, are rare and only a few cases are reported in the literature. These bodies are usually infarcted appendices epiploicae, which become detached and appear as a peritoneal loose body in the abdominal cavity. They may re-attach themselves to a surface, such as the lower aspect of the spleen or omentum, in which case they can be called a "parasitized peritoneal body", as in our case.

Case presentation: We report a case of a giant loose peritoneal body measuring 7 × 5 cm found incidentally in a 64-year-old Indian man who presented with acute intestinal obstruction. We present the current hypothesis and our opinion on the genesis of such large bodies and discuss the problems in diagnosis.

Conclusion: Peritoneal loose bodies are common but giant peritoneal loose bodies are very rare. These giant bodies usually do not require any treatment until they become complicated. Present diagnosis modalities have limitations in the diagnosis of mobile lesions in the abdominal cavity, so care must be taken to avoid unnecessary laparotomies in uncomplicated cases.

Figure 1

Macrograph showing location of the 'boiled egg' (Giant loose peritoneal body) in the abdomen which was something of a surprise to the operating surgeon during exploration and adhesiolysis for acute intestinal obstruction.

Figure 2

Macrograph showing giant peritoneal loose body parasitized to omentum. The macrograph clearly shows the giant loose body attached to omentum and a separate twig from omentum supplying to loose peritoneal body.

Figure 3

Macrograph of giant loose body (cut surface) showing peripheral white & central yellow portions resembling a boiled egg.